Has any study been conducted on gay discordant couples? Is so, what were the
results? I have read some literature for heterosexual couples where the
uninfected person sero-converted from about 1% for those using condoms on a
regular basis to about 12% for those either not using them or using them on
an irregular basis.

Response from Mr. Sowadsky

Hi. Thank you for your question. There have been several studies looking at
HIV risks in Gay discordant couples (where one partner is HIV-positive, and
the other is HIV-negative). Most of these studies looked at how often these
couples engaged in high risk activities (especially unprotected anal
intercourse). Some interesting patterns have arisen over the years.

Generally speaking, it has been shown that Gay men (regardless of HIV status)
are less likely to use condoms for anal sex with their regular (long-term)
partners, than they are with casual/anonymous partners. It has also been
reported that in some (but not all) Gay men, anal intercourse with their
regular partner represented their commitment to each other. Some Gay couples
look at condoms as being a barrier to intimacy, and that not using condoms
shows love and trust in their relationship. Also one study has shown that
there may be a sense of invincibility (a sense that one cannot get HIV) from
a partner in a long-term and intimate relationship. Couples who did not talk
to each other about HIV or safer sex, were also found to have engaged in
unprotected anal intercourse more often, even when the risk for HIV was
known. Studies have shown that in some Gay relationships, some couples did
not consistently use condoms (or use them at all) even when one of the
partners was already known to be positive. In other words, the decision
whether to use condoms or not, was sometimes based on the status of the
relationship (regular partner vs. casual partner), rather than just the HIV
status of the partner. Decisions on condom use among Gay couples are
sometimes based on love and trust, rather than knowledge of HIV transmission.

Condom use among discordant couples (where one partner is HIV-positive, and
the other is HIV-negative) is often greater than condom use among concordant
couples (where either both partners are HIV-negative, or both are
HIV-positive). Also, one study suggested that the "bottom" partner often has
a greater influence regarding the decision on whether to use condoms or not.

Rather than using condoms for anal sex, some discordant couples have chosen
other ways of reducing the risk to the negative partner. Some have had
unprotected anal intercourse without ejaculation. Some have chosen to have
anal intercourse with the positive partner as the receptive ("bottom")
partner. Some have chosen to engage only in oral sex, rather than anal sex.
These strategies may somewhat reduce the risk, but they certainly won't
eliminate the risk! In all of these cases, the negative partner would still
be at significant risk of infection for HIV, and other Sexually Transmitted
Diseases as well. For related topics, see the posts, "Inadvertently Exposed" and "Oral Sex."

In summary, although most Gay discordant couples do use condoms consistently,
there are some discordant couples who do not use condoms every time (or at
all). We therefore cannot assume that discordant couples will always use
condoms, especially if they are in a long-term relationship. There is much
more to the decision to use condoms, than just knowing the HIV status of ones
partner. There are multiple factors that determine condom use (like those
described above). Risk reduction messages to the Gay community must take all
of these factors into account.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).

This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.

Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.

The Body is a service of Remedy Health Media, LLC, 750 3rd Avenue, 6th Floor, New York, NY 10017. The Body and its logos are trademarks of Remedy Health Media, LLC, and its subsidiaries, which owns the copyright of The Body's homepage, topic pages, page designs and HTML code. General Disclaimer: The Body is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.